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The answer is D, pityriasis (tinea) versicolor. This patient has hyperpigmented, scaly, oval-shaped patches with a positive fungal scraping. The morphology along with the more widespread distribution favours pityriasis versicolor over tinea corporis. Spore forms on the fungal scraping (the ‘meatballs’ of the so-called ‘spaghetti and meatballs’ pattern) would help confirm this as well.
The recent history of increased sweating probably played a part in creating a more favourable environment for the yeast Malassezia to convert from normal skin flora to pathogen in this condition. Though treatment is generally effective, it tends to recur in susceptible individuals. Selenium 2.5% or zinc …
Competing interests None.
Provenance and peer review Commissioned; externally peer reviewed.